Provider Demographics
NPI:1033505623
Name:SPEECH WITH BROOKE
Entity Type:Organization
Organization Name:SPEECH WITH BROOKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHERMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC/SLP
Authorized Official - Phone:253-722-9714
Mailing Address - Street 1:PO BOX 65538
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98464-1538
Mailing Address - Country:US
Mailing Address - Phone:253-722-9714
Mailing Address - Fax:866-853-0747
Practice Address - Street 1:2554 LOCUST AVE W
Practice Address - Street 2:SUITE E
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-3561
Practice Address - Country:US
Practice Address - Phone:253-722-9714
Practice Address - Fax:866-853-0747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00004320235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty